How to Get the Most Out of Your Community Experience

• Conduct a preliminary review of your skills
• Ask Questions
• Become an Active Observer
• Work Towards Becoming an Active Participant in the Practice
• Become an Independent Learner
• Consider All Activities of the Practice to be a Learning Experience
• Try to Touch Base with the Preceptor Each Morning

Conduct a preliminary review with your preceptor at the beginning of your clerkship

1. Skills Inventory

You are encouraged to fill out the Clinical Skills Inventory form (link is to .PDF file)and discuss it with your preceptor.

This survey is absolutely not to be used as an evaluation tool. The purpose of the survey is to provide an initial point of discussion for areas to focus on during the month. If you feel uncomfortable with a great many of the items listed on the survey, discuss with your preceptor how you can best focus your experience in his/her practice.

Reason the skills inventory is important: Depending on how many students your preceptor takes during the course of the year, there is likely to be significant variation from one student to the next. Everyone has their own set of strengths and weaknesses. However, depending on when you are taking your Family Medicine Clerkship during the third year, your level of clinical experience compared to your peers also will vary. There is no way your preceptor can know your starting point without some information first.

2. Goals and Objectives of the Clerkship

Be sure you and your preceptor are familiar with the goals and objectives section of the handbook. You may choose to look over this section together, or you may want to do a quick verbal check with your preceptor. Your preceptor should be familiar with the document. However, you will need to take an active role along with your preceptor in achieving these goals. It also will be important to revisit the goals and objectives during a mid-point review. Your preceptor should set a specific time mid-way through the month to discuss your progress and to refocus the experience, if necessary.

3. Discuss your personal goals of the clerkship

Whether or not you are considering a career in family medicine, you probably have some specific clinical interests at this point in your training; discuss them with your preceptor. It may be possible to incorporate them into the experience. Although you will be responsible for the information identified in the “goals and objectives” section, there is enough flexibility that you can incorporate personal goals and interests as well.

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Ask Questions

Speak up! In order to make your clerkship the best learning experience it can be, you will need to ask questions. If you don’t understand what is being done, or why it is being done a certain way, ask. While your preceptor will be trying to get a sense of your knowledge base, you cannot always depend on your preceptor to know when you don’t know something. You can help the process along by becoming an active learner.

An important corollary is to be sure you clarify with your preceptor, up front, when you can ask questions, particularly when a patient is involved.

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Become an Active Observer

Observation can be quite useful in the learning process. However, to derive maximum benefit from these opportunities, watch your preceptor (or other clinical staff) with some specific concepts in mind:

• What is your preceptor’s style of interaction and interview technique?
• What questions is the preceptor asking the patient?
• How is the patient responding to your preceptor?
• How is your preceptor responding to the patient?
• What tests, if any, are being ordered and why?
• What is the evidence for the tests and how much do they cost?
• What is the treatment plan (either previous or current)?
• How is the patient’s context potentially affecting his/her health (i.e. relationships, mental state, environment at home and work, history, etc.)
• What did you like about how the preceptor interacted with the patient?
• What would you have done differently?

These are just a few questions to keep in mind as you are observing. You also may come up with additional questions of your own as you observe. The important point is that you integrate what you are seeing into your thought process and if something does not make sense to you, ask about it.

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Work Towards Becoming and Active Participant in the Practice

Depending upon when this clerkship falls in your third year schedule, you may feel as though you can make some specific contributions from the beginning of your experience. If so, discuss these with your preceptor as you are reviewing your Clinical Skills Inventory. Even if this is your first clerkship, there are ways you can participate. Perhaps, for certain patients, you can take focused histories prior to the preceptor seeing the patient. Working with your preceptor, you also may be able to participate in patient interviews, physical exams, performing and/or interpreting diagnostic tests, and developing management plans.

The ultimate goal is to work towards becoming actively involved. If you feel as though you are spending all of your time observing, talk with your preceptor to see how you might become more actively involved. If you feel as though you are not seeing an adequate variety of patients according to the “common problems” list, by age group, or by gender, speak to your preceptor about trying to increase the variety. Also, be sure there is mutual approval for your level of involvement in the practice.

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Become an Independent Learner

As deemed appropriate by your preceptor, become involved in the care of the patients seen. Read about the problems that you see. Talk with your preceptor about preventive medicine, alternative treatments and the rationales for and against them, cost containment, insurance and billing, staff relations, being on call, balancing the professional and personal aspects of your life, etc. Go out and seek information and discuss your findings with your preceptor. These kinds of conversations will add a new dimension to your experience and will be intellectually stimulating to both you and your preceptor.

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Consider All Activities of the Practice to be a Learning Experience

Try to assume an active and interested role as a partner in your preceptor’s practice. Participate, not only in the office evaluation of patients, but also in administrative and economic planning, hospital rounds (if possible), other types of visits (i.e. home, nursing home, etc.). Talk with the other clinical staff and office staff to learn about how a practice is managed. Find out what they like and don’t like about being in that kind of setting. This information will be useful in helping you understand how a practice operates and may help you in your future career decision-making process.

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Try to Touch Base with the Preceptor Each Morning

It will be helpful to have a sense of how the day is likely to progress. What kinds of patients are you likely to see and for what reasons. Will there be any other kinds of visits made during the day. All of this information will help you prepare yourself for the day ahead.